National Lung Cancer Audit 2022 Report – Where do we go from here?

The National Lung Cancer Audit (NLCA) published its 2022 annual report last week (14th January). 

This report means that data on the outcomes for patients diagnosed with lung cancer between 1 January 2019 and 31 December 2020 in England - and 1 January 2019 and 31 December 2019 in Wales and Guernsey - are now available for local lung cancer teams to analyse, evaluate and use for quality improvement.

This year, for the first time, the NLCA have used the rapid cancer registration dataset for England which makes data available more quickly although it is recognised that it is missing some of the poorer prognosis patients.  Also, it provides data at Cancer Alliance level rather than by ‘Trust first seen’.  However, despite these shortcomings the report does reveal important findings and highlights the deleterious impact that the pandemic has had on the lung cancer pathway.

The report reveals that initiatives, such as the National Optimum Lung Cancer Pathway (NOLCP), were clearly working to improve outcomes prior to the outbreak of the pandemic - with the one-year survival figure in England and Wales reaching at least 40.7% in 2019 – the highest ever achieved.  

However, the latest NLCA data reveal that: “Compared to 2019, lung cancer patients diagnosed in England in 2020 had worse performance status, were more likely to be diagnosed via emergency presentation and less likely to have a pathological diagnosis.” For example, curative treatment rates of good performance status stage I/II NSCLC patients in England dropped from 81% in 2019 to 73% in 2020 and the surgical resection rate fell from 20% to 15%.

Unarguably, COVID-19 has halted progress in lung cancer, putting many of the previous ambitions for improvement at risk. However, we also know that there were many shortcomings in lung cancer diagnosis, treatment, and care prior to the pandemic. Lung cancer has consistently been the UK’s biggest cancer killer.

So how do we address this?  In November 2021 we published our latest report ‘The Route back to 25 by 25’.  This report offers strategic recommendations to get back on track to delivering on our original 2016 ambition of ’25 by 25’ – achieving 25% 5-year survival from lung cancer by 2025.  However, it also calls for an urgent ‘reset’ in lung cancer to address previous deficiencies and inadequacies in the system which meant lung cancer outcomes in the UK continued to lag behind those of comparable countries.

The NLCA has helped to set standards and improve outcomes for patients year-on-year and it remains a vital source of highly-curated data about lung cancer patients in England and Wales. We believe that by following the guidance laid out in our report, we will be able to get back on track for ’25 by 25’ and once again see more positive results in future NLCA datasets.